Form Ct-W4p - Withholding Certifi Cate For Pension Or Annuity Payments - 2013
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6Department of Revenue Services
Form CT-W4P
2013
State of Connecticut
Withholding Certifi cate for Pension or Annuity Payments
(Rev. 12/12)
CT-W4P
Complete this certifi cate in blue or black ink only.
Form CT-W4P allows Connecticut residents who receive pensions
If you are a spouse in a same sex marriage, you must recalculate
or annuities to instruct the payer of the pension or annuity to
your federal adjusted gross income as if your fi ling status for
withhold Connecticut income tax.
federal income tax purposes were married fi ling jointly or married
fi ling separately.
General Instructions
If you wish to have Connecticut income tax withheld from your
You are not required to have Connecticut income tax withheld
pension or annuity payments, you may either:
from your pension or annuity payments. However, you must
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Complete the worksheet on the back of this form to estimate
make estimated Connecticut income tax payments if your
how much income tax to have withheld, round to the nearest
Connecticut income tax (after tax credits) minus Connecticut
whole dollar, but not less than $10, and enter this amount on
income tax withheld is $1,000 or more, and you expect your
Line 1. This option is for people who want to include all income
Connecticut income tax withheld to be less than your required
in determining their withholding amount; or
annual payment.
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If you know how much you want your payer to withhold from
Your required annual payment is the lesser of:
each payment, you may fi ll in a whole dollar amount, but not
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90% of the income tax shown on your 2013 Connecticut
less than $10, on Line 1.
income tax return; or
Where to File
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100% of the income tax shown on your 2012 Connecticut
income tax return if you fi led a 2012 Connecticut income tax
Send this form to the payer of your pension or annuity. Do not
return that covered a 12-month period.
send this form to the Department of Revenue Services (DRS).
If you do not want tax withheld from your pension or annuity
You do not have to make estimated income tax payments if:
payments do not complete or mail this form.
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You were a Connecticut resident during the 2012 taxable year
and you did not fi le a 2012 income tax return because you had
For More Information
no Connecticut income tax liability; or
Call DRS during business hours, Monday through Friday:
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You were a nonresident or part-year resident with Connecticut-
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800-382-9463 (Connecticut calls outside the Greater Hartford
sourced income during the 2012 taxable year and you did not
calling area only); or
fi le a 2012 income tax return because you had no Connecticut
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860-297-5962 (from anywhere).
income tax liability.
TTY, TDD, and Text Telephone users only may transmit inquiries
If you were a nonresident or part-year resident and you did not
anytime by calling 860-297-4911.
have Connecticut-sourced income during the 2012 taxable year,
then you must use 90% of the income tax shown on your 2013
Forms and Publications
Connecticut income tax return as your required annual payment.
Visit the DRS website at to download and print
Connecticut tax forms and publications.
Separate here and mail to the payer of your pension.
Withholding Certifi cate for
Department of Revenue Services
2013 Form CT-W4P
State of Connecticut
Pension or Annuity Payments
First name
Middle initial
Last name
Social Security Number
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Home address
PO Box
Claim or Identification Number (if any) of your
Pension or Annuity Contract
City or town
State
ZIP code
.00
1. Amount of Connecticut income tax you want withheld from each payment ........................... 1.
Signature
Date
Sign
Here
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